Healthcare Provider Details

I. General information

NPI: 1790039725
Provider Name (Legal Business Name): PILSEN MEDICAL CLINIC & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 W NORTH AVE STE 101
ELMHURST IL
60126-2100
US

IV. Provider business mailing address

533 W NORTH AVE STE 101
ELMHURST IL
60126-2100
US

V. Phone/Fax

Practice location:
  • Phone: 312-738-3355
  • Fax: 312-564-5252
Mailing address:
  • Phone: 312-738-3355
  • Fax: 312-564-5252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NASEEM FATIMA
Title or Position: OWNER
Credential: MD
Phone: 925-548-6644